Wilsverklaring: the advance directive in the Netherlands
When you can no longer speak for yourself, a wilsverklaring (advance directive) is one of the few legal tools in the Netherlands that keeps your voice working. It is a written document that records what you want, and what you do not want, in medical situations where you cannot decide in the moment. It is read by your huisarts (general practitioner) and the medical team.
This explainer covers what a wilsverklaring does, the four common types, what is binding and what is not, and how to make sure yours is actually used when it matters.
What a wilsverklaring is, and is not
A wilsverklaring is a personal, written declaration of medical wishes for a future situation in which you are no longer wilsbekwaam (mentally competent to decide). It does not need to be drawn up by a notaris. A handwritten, signed and dated document is, in principle, valid. Many people use templates from the NVVE (Nederlandse Vereniging voor een Vrijwillig Levenseinde) or from the Patiëntenfederatie Nederland.
It is not the same as a testament (which deals with what happens after death) or a levenstestament (which covers financial and personal decisions during life, and is registered with a notaris). The wilsverklaring is specifically medical, and specifically for the moment you cannot speak.
The Patiëntenfederatie Nederland makes a useful distinction: when a wilsverklaring says you do not want a treatment, the doctor is bound to respect it. When it says you do want something, such as euthanasia, it is a request the doctor may consider but is not obligated to fulfil.
The four common types
There is no single national form. Most Dutch wilsverklaringen fall into four categories, often combined in one document.
Behandelverbod (treatment refusal). A statement refusing specific treatments under specific conditions: no resuscitation, no artificial nutrition, no admission to intensive care, no antibiotics in advanced dementia. This is the strongest type. If clearly written, dated and signed, the doctor must follow it.
Niet-reanimerenverklaring or niet-reanimerenpenning (DNR pendant). A specific form of behandelverbod limited to refusing cardiopulmonary resuscitation. The penning is a metal pendant worn on the body, recognised by ambulance personnel and emergency responders. It carries your name, photograph, BSN (citizen service number) and signature. It is intended to be visible immediately on arrival.
Euthanasieverklaring (euthanasia directive). A request, written in advance, that euthanasia be carried out under conditions you specify. Unlike a behandelverbod, this is a request, not a binding instruction. A doctor will consider it alongside the legal due care criteria of the Wet toetsing levensbeëindiging op verzoek en hulp bij zelfdoding (Termination of Life on Request Act). For situations such as advanced dementia, where the person can no longer confirm the wish at the moment, the document carries particular weight, but the decision rests with the doctor.
Volmacht (medical power of attorney). Names a person you trust to make medical decisions on your behalf when you cannot. This person speaks with the doctor, but cannot override a clearly written behandelverbod. Often combined with the other three.
What makes one actually work
A wilsverklaring is only useful if the right people can read it at the right moment. In practice, this means three things.
Discuss it with your huisarts, in advance. A document the doctor has never seen, found in a drawer during a crisis, is harder to act on than one already in your medical file. The conversation also lets your doctor flag wording that is too vague to follow, or treatments that the document forgot to mention. The KNMG (Royal Dutch Medical Association) has long encouraged this conversation as part of advance care planning.
Tell your nabestaanden (next of kin) that it exists, and where. The huisarts has a copy. The family knows that. The volmacht person has been told they have been named. None of this is a surprise on the day.
Update it regularly. A wilsverklaring written ten years ago may not reflect what you would write today. The NVVE recommends reviewing every five years, or sooner if your health, your relationships or your views change. Sign and date the new version; the most recent valid document is the one that counts.
What it does not do
A wilsverklaring does not apply when you are still wilsbekwaam. As long as you can express a decision, even briefly and even under stress, your spoken word in that moment overrides the document.
It does not bind a doctor to perform euthanasia. The doctor must always be able to reach personal conviction that the legal due care criteria are met. With advanced dementia in particular, the gap between what the document asks and what the doctor can act on is often significant.
It does not replace conversation with your family. The document tells the doctor what to do. Your family will live with the decision. They generally do better when they have heard your reasoning, not just read your conclusion.
Where to get one
The two most-used sources for templates and guidance are NVVE, which offers members assistance in drafting and a digital tool, and Patiëntenfederatie Nederland, which publishes free guidance for the general public. The huisarts can also provide standard forms or annotate one you bring in.
There is no central national register for wilsverklaringen. The most reliable storage is a copy in your medisch dossier (medical file) at the huisarts, plus a copy in your readiness folder at home, plus a note in your wallet or with the niet-reanimerenpenning, if you wear one.
In the app
The Personal Portal has Stage 4 (Legal Papers) where you record whether your wilsverklaring exists, what type, and where it is kept. Stage 5 (Guide for Your Family) lets your family find it in the first hours. The app does not draft the directive — discuss the wording with your huisarts — but the Zorgmap keeps the document visible to the right people.
Closed beta — access by invitation.
Sources
- NVVE — Nederlandse Vereniging voor een Vrijwillig Levenseinde, information and templates for wilsverklaringen, including the niet-reanimerenpenning. https://www.nvve.nl
- Patiëntenfederatie Nederland — public guidance on wilsverklaring, behandelverbod and the difference between refusals and requests. https://www.patientenfederatie.nl
- KNMG — Royal Dutch Medical Association, professional guidelines on advance care planning and the role of the huisarts. https://www.knmg.nl